Provider Demographics
NPI:1619316858
Name:WAY OF LIFE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:WAY OF LIFE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-217-7632
Mailing Address - Street 1:1221 W COLONIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7163
Mailing Address - Country:US
Mailing Address - Phone:407-287-6076
Mailing Address - Fax:407-347-2092
Practice Address - Street 1:1221 W COLONIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7163
Practice Address - Country:US
Practice Address - Phone:407-287-6076
Practice Address - Fax:407-347-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health